EMplify by EB Medicine

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Education
**EMplify by EB Medicine**

Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!

Latest Episodes:

Episode 62 - Cervical Spine Injuries- An Interview with Dr. Jara-Alamonte Oct 04, 2021

Show notes

EMplify - October 2021

Announcements:

The EB Medicine app is live and available for free in the Apple Store. Coming to Google Play soon. It is in Beta and your feedback is welcome. ,
Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net

Emergency Dept. Management of Cervical Spine Injuries

Authors:

Geoffrey Jara-Alamonte, MD

Chandni Pawar, MD

Epidemiology

Anatomy (Figure 2 +3)

Spinal Cord Injury Injury (Table1)

Primary
Secondary

Differential Diagnosis

Prehospital Care - selective immobilization

ED evaluations

History
Physical Exam (Table 6)
Imaging
Vascular Injury - Modified Denver Criteria (table 9)
Treatment
Special Populations
Pediatrics

Episode 61 - Abnormal Uterine Bleeding Sep 08, 2021

Show notes

EMplify - September 2021

Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net !

Abnormal Uterine Bleeding in the Emergency Department

Authors:

Tazeen Abbas, MD

Abbas Husain, MD, FACEP

Physiology review
Terminology
Differentiating Causes: PALM-COEIN
Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia
Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified
Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise
Age Based Differential
12-18
Immaturity of the hypothalamic-pituitary- ovarian axis
Sexually transmitted infections
Coagulopathies, and bleeding disorders (von Willibrand disease)
19-39
polyps
fibroids
malignancy
PCOS
Age 40 and older
endometrial atrophy
malignancy
History
Physical Exam
Diagnostic Studies
Treatment
Unstable
Stable
Special Cases
DOACs
Prepubescent girls
genital injuries

Episode 60 – Less Lethal Law Enforcement Weapons Aug 10, 2021

Show notes

EMplify – August 2021

Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !!

August 2021 Pediatric Emergency Medicine Practice

Less Lethal Law Enforcement Weapons

Authors: Jessica Osterman, MD , Cara Buchanan, MD

What kinds of less-lethal weapons are law enforcement using?

Pepper spray
Conducted Electrical Weapons (CEWs)
K-9s
Beanbag guns
Rubber bullets
Stingballs

Differential Diagnosis

Prehospital Care

Trauma Informed Care

Conductive Electrical Weapons – Taser

Chemical Irritants- Pepper Spray, Tear Gas

K9 Injuries

Kinetic Impact Projectiles- Rubber Bullets, Beanbags, Sting Balls/Grenades

Sounds:

Police Siren https://freesound.org/people/MultiMax2121/sounds/156869/

Ambulance https://freesound.org/people/sofialomba/sounds/469413/

Angry Man https://freesound.org/people/ebcrosby/sounds/334439/

Taser https://freesound.org/people/The_Chemical_Workshop/sounds/403252/

Taser https://freesound.org/people/Greub/sounds/402636

Coughs https://freesound.org/people/freesound/sounds/25301/

Dog Bark https://freesound.org/people/ivolipa/sounds/337101/

Grenade https://freesound.org/people/superfreq/sounds/268101/

Last Updated on April 29, 2022

Episode 59 – HIV – An Interview With Dr. Daniel Egan Jul 02, 2021

Show notes

EMplify – July 2021

Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !!

HIV- An Interview With Dr. Daniel Egan

See the EB Medicine Article @ https://www.ebmedicine.net/topics/infectious-disease/HIV

Why HIV?
2018 , 1,2 million people living with HIV, almost 40k new infections
People living with HIV visit the ED 3 x per year on average
HIV infected patients accounted for 6 in 1000 ED visits in 2017
New Transmission of HIV, Figure 1
What does acute infection look like ?
What about chronic infection ?The chronic phase can last 10 years or more and be asymptomatic.
Are people with HIV more likely to develop: CAD, COPD, DVT and why?
What if they are on medication for HIV?
Screening in the ED, everyone? Do they have to have symptoms or risks?
What does universal screening mean?
What does risk based screening mean?
What are the risk factors? What if I see someone on PrEP who is in the ED for an unrelated complaint?
History
Ask about cd4 and viral load and last test
Ask about he of opportunistic infections
Ask about medication side effects
What else?
Exam
Labs – rapid testing, 4th gen, viral load and cd4, etc
Imaging
Treatment
Table 1
Highly effective and reduces transmission
Medication side effects (we don’t have to dwell on each Med and side effect and just reference the charts)
hep B virus deactivation
System Based Disease
Heart Failure and CAD
PCP (role of LDH)
TB
COPD
Renal Disease – stones , radiolucent
Neurologic- CVA, cryptococcal meningitis, toxo, progressive multi focal leukoencephalopathy, HAND
GI – diarrhea causes, c diff, hep C
Heme- cytopenia
Endocrine – metabolic syndrome
Musculoskeletal
Psychiatric table 3
Derm
Special Circumstances
PEP
PrEP

Episode 58 – Syncope – An Interview With Dr. James Morris Jun 01, 2021

Show notes

EMplify - June 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Syncope- An Interview With Dr. James Morris See the EB Medicine Article @ https://www.ebmedicine.net/topics/cardiovascular/syncope Why syncope? Prevalence, hospitalizations, etc. Etiology: figure 1 is fantastic. Physiologic basis of syncope Neurally mediated Orthostatic - are we still doing orthostatic vitals in the ED? Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Prehospital care is all about details What did bystanders see? What do paramedics see? Any trauma? Any neuro deficits ? Glucose ECG ED History - table 4 History of similar Prodrome Associated symptoms (chest pain, neuro symptoms, etc) Falls Pre-syncope ? ED exam Vitals, vitals, vitals Orthostatic vitals ? Carotid sinus massage, why this? Do we do in the ED? ECG Brugada, blocks, VT, ST changes, etc Labs BNP, delta bnp ? Trop Lactic acid Pregnancy test CBC lutes Bun/Cr Echo - any role in the ED? CT Head PE- get this on everyone ? Is it high prevalence? Risk stratification tools- the bad and the worse Table 7, amazing Controversies Admitting the elderly Orthostatic vitals (we discussed already) Disposition

Episode 57 – Atrial Fibrillation : An Approach To Diagnosis And Management In The Emergency Department May 04, 2021

Show notes

EMplify - May 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Atrial Fibrillation : An Approach To Diagnosis And Management In The Emergency Department - An Interview with Dr Brian Millman Epidemiology Causes Prehospital treatment - careful with causes of the A Fib. ED Evaluation History - beware the causes Physical ECG Labs Imaging Echocardiography Treatment Rate control Calcium channel blockers Beta blockers Esmolol Magnesium Rhythm control Amiodarone Procainamide Cardioversion Watch and Wait Anticoagulation Disoposition

Episode 56 - Management of Suspected Rabies Exposure in the Emergency Department Apr 06, 2021

Show notes

EMplify - April 2021

Announcements

Traumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/register
Pandemic Preparedness publication is coming soon.
Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: https://www.ebmedicine.net/topics/COVID-19/Protocols
The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com

Management of Suspected Rabies Exposure in the Emergency Department - An Interview with Dr. Bess Storch

Epidemiology:

Fatality rate of over 99%
Half of cases occur in children
95% of cases are in resource limited countries, 35% in India
99% caused by infected dogs (worldwide)
In the US, cases are predominantly bat variant

Why this topic?

"In a recent survey of licensed physicians, less than half could identify rabies transmission routes, the correct PEP schedule, and the correct anatomic administration sites."

Pathophysiology:

What causes it? The RNA virus Lyssavirus
How is it transmitted?
How does it reach the brain?

ED Evaluation:

What does it look like clinically?
5 stages- incubation, prodrome, acute neurologic phase, coma death
Why doesn’t everyone just get vaccinated?
What patient medical history is important ? Steroids, chloroquine
What animals are high risk?
What about pets and quarantine?
What about rodents ?
Is there any role for labs or imaging ?
What is the treatment regimen for those who are unvaccinated? And vaccinated?
What about people who are immunosuppressed?
Children?
Pregnant?
Recently traveled?

Episode 55 -Management of Acute Urinary Retention in the Emergency Department Mar 01, 2021

Show notes

EMplify - March 2021

Management of Acute Urinary Retention in the Emergency Department

An algorithmic approach to urinary retention.
Relieve the obstruction

Foley
Cudet cather
Silicone catheter
Suprapubic catheter

Determine the cause -

Structural
Medications / Toxicologic
Neurologic
Infectious

Alpha blockers
Antibiotics
Slow vs rapid bladder decompression
Admit or discharge
Phimosis and Paraphimosis

Announcements:

New Airway Course Available: Current Topics in Airway Management: Mechanical Ventilation, Supraglottic Airway Devices, and Intubating Patients With COVID-19
Upcoming Live Course: Dr. Scott Weingart - Traumatic Hemorrhage - April 13th., 8-9pm, EST
Look for the "Key Points And Pearls From 2020" coming to your inbox or mailbox next month !

Episode 54 - Community-Acquired Pneumonia in the Emergency Department - Interview with Matthew DeLaney, MD Feb 01, 2021

Show notes

EMplify - February 2021

Community Acquired Pneumonia - An Interview with Dr. Matthew DeLaney, FACEP

1. Pneumonia and nomenclature : healthcare associated vs hospital associated

2. COVID-19 and antibiotics

3. Bacteriology - Strep is only 10-15% of hospitalized pneumonia, Viral pneumonia is about 20% (pre covid)

4. Conditions that predispose to pneumonia

chronic lung disease (chronic obstructive pulmonary disease, bronchiectasis)
smoking
older age
immuno-compromise
proton-pump inhibitors, H2 blockers, and antipsychotic agents

5. Is there a historical or exam item most likely to be indicative of pneumonia?

6. How good is a CXR?

7. When should I consider a CT if the CXR is normal?

8. Procalcitonin

9. Blood cultures, sputum cultures, urine antigens- are these helpful?

10. CURB-65 vs PSI

11. Antibiotics- table 3 major and minor, history of prior infection, and doxy for everyone !

12. Duration - 5 days works

13. A walk through the pathway

Episode 53- Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department Jan 07, 2021

Show notes

EMplify January 2021

Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department

Authors

Marshall Frank, DO, MPH, FACEP

Carson Sanders, BS, NRP, CCEMT-P

Bryan P. Berry, MD, BCEM, FACEP

Topics

Epidemiology

Pathophysiology

Prehospital care

Emergency Dept Evaluation

History
Physical

Imaging

Labs

Electrocardiogram

aVR
Posterior Leads
LBBB
Serial ECGs
Reciprocal Changes
Pericarditis vs STEMI

Treatment

Oxygen
Opioids
Antiplatelet Agents
Nitroglycerin
Beta Blockers
Reperfusion
PCI
Thrombolytics
Dysrhythmias
Anticoagulants

Transfers

Special Circumstances

Gender
Age
Cocaine

Have questions or comments on the podcast? Write us at emplify@ebmedicine.net .

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